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Directional coronary atherectomy plus stent implantation vs. left internal mammary artery bypass grafting for isolated proximal stenosis of the left anterior descending coronary artery
Author(s) -
Brambilla Nedy,
Repetto Alessandra,
Bramucci Ezio,
Canosi Umberto,
Ferrario Maurizio,
Angoli Luigi,
Aiello Marco,
Rinaldi Mauro,
Klersy Catherine,
Viganò Mario,
Tavazzi Luigi
Publication year - 2005
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20214
Subject(s) - medicine , mace , stent , cardiology , clinical endpoint , stenosis , artery , surgery , percutaneous coronary intervention , myocardial infarction , randomized controlled trial
The aim of this study was to compare the short‐ (< 30 days) and long‐term (≥ 30 days) clinical outcomes of left internal mammary artery bypass grafting (LIMA‐LAD) and directional coronary atherectomy plus stent implantation (DCA + stent) in the treatment of isolated proximal left anterior descending coronary (LAD) lesions. One hundred and twenty‐six patients underwent LIMA‐LAD and 132 consecutive patients underwent DCA + stenting. The primary endpoint was the incidence of short‐ and long‐term major adverse cardiac events (MACE); the secondary endpoints included any periprocedural events and long‐term target vessel revascularization (TVR). We found no significant between‐treatment difference in the occurrence of short‐term MACE, and the long‐term MACE rate per 100 person‐years was 3.0 in the LIMA‐LAD group and 4.6 in the DCA + stent group. After 5‐year follow‐up, 79% of the patients in the DCA + stent group and 89% of those in the LIMA‐LAD group were still MACE‐free. The risk of any periprocedural events was six times lower in the DCA + stent group, and the risk of TVR was six times higher. We conclude that both procedures lead to good short‐ and long‐term follow‐up results in isolated proximal LAD disease. As fewer periprocedural events and more TVRs occur after DCA + stenting than after LIMA‐LAD, they can be considered valuable alternatives to each other. Catheter Cardiovasc Interv 2005;64:45–52. © 2004 Wiley‐Liss, Inc.